The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations. Final boundary between the Republic of Sudan and the Republic of South Sudan has not yet been determined.
*Dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties.

Undernutrition contributes to half of all deaths in children under 5 and is widespread in Asia and Africa

Nearly half of all deaths in children under 5 are attributable to undernutrition. This translates into the unnecessary loss of about 3 million young lives a year. Undernutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and contributes to delayed recovery. In addition, the interaction between undernutrition and infection can create a potentially lethal cycle of worsening illness and deteriorating nutritional status. Poor nutrition in the first 1,000 days of a child’s life can also lead to stunted growth, which is irreversible and associated with impaired cognitive ability and reduced school and work performance.

Measures of child undernutrition are used to track progress towards Millennium Development Goal 1: Eradicate extreme poverty and hunger. Sub-Saharan Africa is falling far behind all other regions with regard to potential achievement of the target 50% reduction in underweight prevalence between 1990 and 2015. Meanwhile, the number of overweight children worldwide – another aspect of malnutrition – is growing at a brisk pace.

Stunting

In 2013, one in four children under age 5 worldwide had stunted growth. That said, overall trends are positive. Between 2000 and 2013, stunting prevalence globally declined from 33 per cent to 25 per cent, and the number of children affected fell from 199 million to 161 million. In 2013, about half of all stunted children lived in Asia and over one third in Africa.

Between 2000 and 2013, stunting declined from one third to one quarter of children under 5 worldwide

Percentage of children under 5 who are stunted, by region, 1990 to 2013

*Consecutive low population coverage for the 2013 estimate, interpret with caution.

**Due to consecutive lack of any data, results are not displayed for year 1990 for the Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS). Also, due to missing data, Russia is not included.

Between 2000 and 2013, stunting declined from one third to one quarter of children under 5 worldwide

Percentage of children under 5 who are stunted, by region, 1990 to 2013

*Consecutive low population coverage for the 2013 estimate, interpret with caution.

**Due to consecutive lack of any data, results are not displayed for year 1990 for the Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS). Also, due to missing data, Russia is not included.

Underweight

Worldwide, 99 million children under age 5 were underweight in 2013. Underweight prevalence continues to decline, but at a slow pace. Between 1990 and 2013, it decreased from 25 per cent to 15 per cent of the under-five population worldwide. If current trends continue, the MDG 1 target (halving the 1990 underweight prevalence by 2015 at the global level) will not be met. Three regions, however, have already met or exceeded the target: East Asia and the Pacific, Latin America and the Caribbean, and Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS). Africa has experienced the smallest relative decrease, with underweight prevalence of 17 per cent in 2013, down from 23 per cent in 1990; Asia reduced underweight prevalence during the same period from 32 per cent to 18 per cent.

Underweight prevalence continues to decline, but not fast enough to meet the MDG in West and Central Africa

Percentage of children under 5 who are underweight, by region, 1990 to 2013

*Consecutive low population coverage for the 2013 estimate, interpret with caution.

**Due to consecutive lack of any data, results are not displayed for year 1990; the CEE/CIS region does not include Russia due to missing data.

Overweight

Worldwide, in 2013, 42 million children under age 5 were overweight, up from 32 million in 2000. Trends suggest that this number will continue to rise. Between 2000 and 2013, overweight prevalence increased from 1 per cent to 19 per cent of the under-five population in Southern Africa. The rise in overweight prevalence is reflected in all regions, with the greatest absolute and relative increases in CEE/CIS. While the numbers of children affected have been steady in Latin America and the Caribbean and decreasing in East Asia and the Pacific, they have been increasing in all other regions. Despite the decline in East Asia and the Pacific, the region had the highest number of overweight children in 2013. Of particular concern is the rise in the number of both stunted and overweight children in West and Central Africa, whose health-care systems are ill-equipped to manage this double – and growing – burden of malnutrition.

In most regions, the proportion of overweight children continues to rise

Percentage of children under 5 who are overweight, by region, 1990 to 2013

*Consecutive low population coverage for the 2013 estimate, interpret with caution.

**Due to consecutive lack of any data, results are not displayed for year 1990; the CEE/CIS region does not include Russia due to missing data.

Wasting and Severe Wasting

In 2013 globally, 51 million children under 5 were wasted and 17 million were severely wasted. This translates into a prevalence of almost 8 per cent and just less than 3 per cent, respectively. In 2013, approximately two thirds of all wasted children lived in Asia and almost one third in Africa, with similar proportions for severely wasted children. South Asia’s wasting prevalence indicates a ‘critical’ public health problem; that of sub-Saharan Africa represents a ‘serious’ need for intervention with appropriate treatment programmes. Under-five wasting and severe wasting are highly sensitive to change. Thus, estimates for these indicators are only reported for current levels (2012).

The prevalence of wasting in South Asia is so severe it is regarded as a critical public health problem

Percentage of children under 5 who are wasted and severely wasted, by region, 2013

*Consecutive low population coverage for the 2013 estimate, interpret with caution.

Disparities

In almost all countries with available data, stunting rates are higher among boys than girls. While analyses to determine underlying causes for this phenomenon are underway, initial review of the literature suggests that the higher risk for preterm birth among boys (which is inextricably linked with lower birth weight) is a potential reason for this sex-based disparity in stunting.

Boys are more likely to be stunted than girls in most countries

Percentage of boys under 5 who are stunted (y-axis), vs percentage of girls under 5 who are stunted (x-axis), by region, 2012

Children from the poorest 20 per cent of the population are more than twice as likely to be stunted as those from the richest quintile. In South Asia, the disparities between the richest and poorest children in regard to stunting are greater than in any other region. Generally, children residing in rural areas are more likely to be stunted than their urban counterparts.

Poorer children are far more likely than their richer counterparts to experience stunted growth

Percentage of children under 5 who are stunted, by wealth quintile and by region, 2012

Notes: Analysis based on a subset of countries with available data by subnational groupings; regional estimates represent data from countries covering at least half of the regional population. Data are from 2007 to 2011, except for Brazil and India. Excludes China.

Poorer children are far more likely than their richer counterparts to experience stunted growth

Percentage of children under 5 who are stunted, by wealth quintile and by region, 2012

Notes: Analysis based on a subset of countries with available data by subnational groupings; regional estimates represent data from countries covering at least half of the regional population. Data are from 2007 to 2011, except for Brazil and India. Excludes China.

Progress in reducing underweight prevalence also shows inequities between the rich and the poor. In India, for example, no significant improvement has been noted in underweight prevalence among children from the poorest quintile over the period from around 1993 to around 2006. Meanwhile, children in the richest quintile showed a drop of about one third.

In India, progress against underweight in children is steady among the richest children, but has stagnated among the poorest

Percentage of children under 5 who are underweight in India, by wealth quintiles, 1993, 1999 and 2006

Notes: Prevalence estimates are calculated according to the National Center for Health Statistics reference population, since there were insufficient data to calculate trend estimates by wealth quintiles according to WHO’s Child Growth Standards. Estimates are age-adjusted to represent children under 5 in each survey.

Source: National Family Health Surveys, 1992–1993, 1998–1999 and 2005–2006.

In India, progress against underweight in children is steady among the richest children, but has stagnated among the poorest

Percentage of children under 5 who are underweight in India, by wealth quintiles, 1993, 1999 and 2006

Notes: Prevalence estimates are calculated according to the National Center for Health Statistics reference population, since there were insufficient data to calculate trend estimates by wealth quintiles according to WHO’s Child Growth Standards. Estimates are age-adjusted to represent children under 5 in each survey.

Source: National Family Health Surveys, 1992–1993, 1998–1999 and 2005–2006.

This report builds on earlier findings on the impact of undernutrition by highlighting new developments and demonstrating that efforts to scale up nutrition programmes are working, benefiting children in many countries.

The UNICEF-WHO-World Bank Child Malnutrition Dashboard allows users to generate a variety of graphs and charts, using the newest joint estimates for child malnutrition which encompass all available data up to June 2013. Estimates of prevalence and numbers for child stunting, underweight, overweight and wasting are presented by the Agency Classifications of United Nations, Millennium Development Goal, UNICEF regions, WHO regions, World Bank income groups and World Bank regions.

UNICEF, WHO and the World Bank released an updated joint dataset on child malnutrition indicators (stunting, wasting, severe wasting, overweight and underweight) and new global & regional estimates for 2013 with 95% confidence intervals in September 2014 through an interactive dashboard. This summary note presents key messages and highlights refinements to the method.

INDICATORS

Number of under-fives falling below minus 2 standard deviations (moderate and severe) and minus 3 standard deviations (severe) from the median height-for-age of the reference population

Children under 5 years of age in the surveyed population

Underweight

Number of under-fives falling below minus 2 standard deviations (moderate and severe) and minus 3 standard deviations (severe) from the median weight-for-age of the reference population

Children under 5 years of age in the surveyed population

Wasting

Number of under-fives falling below minus 2 standard deviations (moderate and severe) and minus 3 standard deviations (severe) from the median weight-for-height of the reference population

Children under 5 years of age in the surveyed population

Overweight

Number of under-fives above 2 standard deviations from the median weight-for-height of the reference population

Children under 5 years of age in the surveyed population

REFERENCE POPULATION

Prevalence of underweight, stunting and wasting among children under 5 is estimated by comparing actual measurements to an international standard reference population. In April 2006, the World Health Organization released the WHO Child Growth Standards to replace the widely used National Center for Health Statistics (NCHS)/WHO reference population, which was based on a limited sample of children from the United States of America. The new standards are the result of an intensive study project involving more than 8,000 children from Brazil, Ghana, India, Norway, Oman and the United States. Overcoming the technical and biological drawbacks of the old reference population, the new standards confirm that children born anywhere in the world and given the optimum start in life have the potential to reach the same range of height and weight. It follows that differences in children's growth to age 5 are more influenced by nutrition, feeding practices, environment and health care than by genetics or ethnicity.

The new standards should be used in future assessments of child nutritional status. It should be noted that because of the differences between the old reference population and the new standards, prevalence estimates of child anthropometry indicators based on these two references are not readily comparable. It is essential that all estimates are based on the same reference population (preferably the new standards) when conducting trend analyses.

ADJUSTING COUNTRY-LEVEL ESTIMATES

Before conducting trend analyses of child nutritional status, it is important to ensure that estimates from various data sources are comparable over time. For example, household surveys in some countries in the early 1990s only collected child anthropometry information among children up to 47 months of age – or even up to only 35 months of age. Prevalence estimates based on such data only referred to children under 4 or under 3 years of age and are not comparable to prevalence estimates based on data collected from children up to 59 months of age. Some age adjustment needs to be applied to make these estimates based on non-standard age groups comparable to those based on the standard age range. For more information about age adjustment, please click here to read a technical note. In addition, prevalence estimates need to be calculated according to the same reference population. Those calculated according to the WHO Child Growth Standards are not comparable to those calculated according to the NCHS/WHO reference population. For more information about the difference between the two references and its implications, please click here to read a technical note.

ESTIMATING COUNTRY-LEVEL PROGRESS

Country-level progress in reducing undernutrition prevalence is evaluated by calculating the average annual rate of reduction (AARR) and comparing this to the AARR needed in order to be able to reduce prevalence by half over 25 years. For more information about how to calculate country-level AARR, please click here to read a technical note.

ESTIMATING REGIONAL TRENDS BY MULTILEVEL MODELLING

Estimation of regional and global trends has been based on a multilevel modelling method (see de Onis et al. in JAMA, 2004). For the most recent trend analysis presented below, a total of 716 data points from 145 countries over the period 1985 to 2013 were included in the model. This set of trend data points was jointly reviewed by UNICEF and WHO in June and July 2014 to ensure that it is nationally representative of under-five children, processed using standard algorithms and comparable vertically and horizontally. Regional trend modelling and graphing were carried out using STATA 11 on two ‘do’ files (the data set and do files are available on request).

Note: * CEE/CIS: Central and Eastern Europe and the Commonwealth of Independent States.

How to read this chart:

Each circle (bubble) represents a prevalence estimate from a country in a data year. The size of the circle is proportional to the under-five population in that country in the data year. For each region, a solid line indicates the regional trend as modelled by the multilevel logit regression on all the available data points in the region. The dashed lines in each region indicate the lower and upper bounds of the regional trend line corresponding to the confidence interval of the estimated trend.